Gastroenterology and Hepatology, Mount Sinai West & Mount Sinai St. Luke's Hospitals, New York, NY, USA.
Gastroenterology and Hepatology, Hahnemann University Hospital, Philadelphia, PA, USA.
Dis Esophagus. 2019 Mar 1;32(3). doi: 10.1093/dote/doy099.
The 4-quadrant forceps biopsy (FB) protocol for identifying Barrett's esophagus (BE) and esophageal dysplasia (ED) suffers from poor sensitivity due to significant sampling error. We investigated the benefit of wide-area transepithelial sampling with 3-dimensional computer-assisted analysis (WATS) used adjunctively to the combination of random and targeted FB in the detection of ED, and as a secondary outcome, BE. In this multicenter prospective trial, community endoscopists at 21 sites utilized WATS as an adjunct to both targeted and random FB in patients undergoing BE screening and surveillance. Investigators alternated taking FB and WATS samples first. WATS specimens were analyzed at CDx Diagnostics (Suffern, NY) while FB samples were analyzed by each site's regular pathologists. Data were de-identified and then aggregated for analysis. Of 12,899 patients enrolled, FB identified 88 cases of ED, and WATS detected an additional 213 cases missed by FB. These 213 cases represented an absolute increase of 1.65%, raising the yield from 0.68% to 2.33%. Adding WATS to FB increased the overall detection of ED by 242% (95% CI: 191%-315%). Fewer than 61 patients needed to be tested with WATS to identify an additional case of ED. The combination of random and targeted FB identified 1,684 cases of BE, and WATS detected an additional 2,570 BE cases. The absolute incremental yield of adding WATS to FB is 19.9%, increasing the rate of detection from 13.1% to 33%. Adding WATS to FB increased the overall detection of BE by 153% (95% CI: 144-162%). The number needed to test with WATS in order to detect an additional case of BE was 5. Whether FB or WATS was done first did not impact the results. In this study, comprised of the largest series of patients evaluated with WATS, adjunctive use of the technique with targeted and random FB markedly improved the detection of both ED and BE. These results underscore the shortcomings of FB in detecting BE-associated neoplasia, which can potentially impact the management and clinical outcomes of these patients.
四象限活检（FB）方案用于识别 Barrett 食管（BE）和食管异型增生（ED），但由于采样误差较大，其敏感性较差。我们研究了广泛的跨上皮采样（WATS）与随机和靶向 FB 联合应用在 ED 检测中的益处，以及作为次要结果的 BE 检测。在这项多中心前瞻性试验中，21 个地点的社区内镜医生在 BE 筛查和监测中，将 WATS 作为靶向和随机 FB 的辅助手段。研究者交替首先进行 FB 和 WATS 取样。WATS 标本由 CDx Diagnostics（纽约州萨芬）进行分析，而 FB 标本则由每个地点的常规病理学家进行分析。数据被去识别，然后汇总进行分析。在 12899 名入组患者中，FB 发现 88 例 ED，WATS 额外发现 FB 遗漏的 213 例。这 213 例绝对增加了 1.65%，使检出率从 0.68%提高到 2.33%。将 WATS 添加到 FB 中，使 ED 的总体检出率增加了 242%（95%CI：191%-315%）。需要测试的患者少于 61 人，即可额外发现 1 例 ED。随机和靶向 FB 联合检测发现 1684 例 BE，WATS 检测发现另外 2570 例 BE。将 WATS 添加到 FB 中，绝对增量为 19.9%，检测率从 13.1%提高到 33%。将 WATS 添加到 FB 中，使 BE 的总体检出率增加了 153%（95%CI：144-162%）。需要测试的患者少于 5 人，即可额外发现 1 例 BE。无论 FB 还是 WATS 首先进行，结果都没有影响。在这项研究中，使用 WATS 评估了最大系列的患者，该技术与靶向和随机 FB 联合应用，显著提高了 ED 和 BE 的检测率。这些结果突显出 FB 在检测 BE 相关肿瘤方面的局限性，这可能会影响这些患者的管理和临床结果。
